Healthcare Provider Details

I. General information

NPI: 1508808320
Provider Name (Legal Business Name): THOMAS ROAD URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E THOMAS RD STE. A104
PHOENIX AZ
85016-7646
US

IV. Provider business mailing address

PO BOX 20937
MESA AZ
85277-0937
US

V. Phone/Fax

Practice location:
  • Phone: 480-776-1588
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN SHUFELDT
Title or Position: CEO
Credential: M.D
Phone: 480-924-8382